Stroke Syndromes

Question 1

General definition of a stroke

Answer 1

A “brain attack” brought about by an acute impairment of CNS blood supply

Question 2

Hemorrhagic stroke

Answer 2

A stroke in which a vessel ruptures and causes bleeding (less common)

Question 3

What are some risk factor for hemorrhagic stroke

Answer 3

HBP,atherosclerosis, diabetes, or anything that would weaken vessel walls

Question 4

What is the clinical triad of symptoms associated with a subarachnoid hemorrhage

Answer 4

Worst headache ever,
2,
3
And the crab of death

Question 5

Ischemic stroke characteristics

Answer 5

A vessel occluded by something (more common)

Question 6

Results of occlusion of a vessel

Answer 6

Hypoxia (at risk) decreased levels of o2

Anoxia (dying)
No o2 and stain red under eosin and this doesnt occur in any other condition.

Question 7

Lacunae infant

Answer 7

A small infarcted area from the occlusion of a small end artery

Question 8

Watershed infarct

Answer 8

Occurs between the distribution of two major arteries

Question 9

TIA definition

Answer 9

An acute transient neurological episode caused by ischemia. Important to recognize c=because ~80% of individuals who have them will go on to have a major stroke within the next 3 years

Question 10

Why is it thought that ischemic cascades take place

Answer 10

It is thought to set off an expcitotic cascade due to the accumulation of glutamate int he interstitial space as well as the excess release of calcium

Question 11

What is the penumbra

Answer 11

An area surrounding the principal stroke area where damage is potentially reversible

Question 12

What is typical treatment for ischemic strokes

Answer 12

Clot buster type treatments must be administered within specific time windows to be effective

Question 13

A lesion of the optic chiasm produces what

Answer 13

A bilateral hemianopsia

Question 14

Blood supply to the cerebral cortex

Answer 14

ACA, MCA, PCA

Question 15

Blood supply to the ccorpus striatum and internal capsule

Answer 15

MCA and ACA

Question 16

Blood supple to the neural retina

Answer 16

CRA (inner retina)

Question 17

Blood supply to the thalamus

Answer 17

PCA, posterior communicating and anterior choroidal arteries

Question 18

Blood supply to the midbrain

Answer 18

PCA and basillar artery

Question 19

Blood supply to the pons

Answer 19

Basillar artery

Question 20

Blood supply to the medulla

Answer 20

Basillar and vertebral artery

Question 21

Blood supply to the cerebellum

Answer 21

SCA, AICA, PICA

Question 22

Blood supply to the spinal cord

Answer 22

Anterior and posterior spinal arteries

Question 23

What are the branches of the ICA

Answer 23

Opthalmic, anterior choroidal, ACA, middle cerebral, poster communicating

Question 24

Amaurosis fugax

Answer 24

Sudden transient loss of vision on one side that can be the result of a TIA of the ICA

Question 25

What are the signs and symptoms of an ICA stroke

Answer 25

Contralateral: spastic paralysis/paresis with a babinski/paralysis of the lower face
-loss of fine touch, vibration, and conscious proprioception of the face and body (S1)

Ipsilateral signs:
May show ipsilateral visual loss,

May show global aphasia

Question 26

Strokes of the MCA

Answer 26

Contralateral signs:
Spastic paralysis/paresis, loss of fine touch, vibration, conscious proprioception, and difficulty in precise location of pain (ALL UPPER>LOWER), and lower facial paralysis/paresis

Other:
Eye deviation to the side of the lesion, non dominant=neglect
Dominant=global aphasia

Question 27

ACA strokes

Answer 27

Spastic paralysis/paresis with a babinski and loss of fine touch etc lower>upper

Other: abulia, urinary incontinence

Question 28

PCA strokes

Answer 28

Contralateral homonymous hemianopia (with macular sparing due to MCA supply), and memory deficits (parahippocampal gyrus)

Question 29

Stroke of the small penetrating branches of the MCA–>lenticulo-striate branches specifically lateral striate

Answer 29

They supply the genu and posterior limb of the internal capsule

Would see contralateral paralysis with a babinski and loss of fine touch etc, and the inability to localize pain, lower facial paralysis.

You will not see cortical signs with an internal capsule stroke

Question 30

Strokes of the thalamus involve what arteries and what are the signs

Answer 30

PCA. Symptoms will be specific to the nucleus involved. Thalamic syndrome can result

Question 31

Stroke at the level of the superior colliculus

Weber Syndrome

Answer 31

Weber syndrome:
PCA, basal midbrain (crus cerebri/CN III LMN)
Contralateral:
Spastic para w babinski/para of the lower face
Ipsilateral:
Occulomotor opthalmoplegia

Question 32

Stroke at the level of the superior colliculus

Claude’s Syndrome

Answer 32

Claude’s Syndrome: PCA or basillar. Contralateral tremor and ipsilateral opthalmoplegia

Question 33

Stroke at the level of the superior colliculus

Benedikts syndrome

Answer 33

Benedikts syndrome:basilar artery. And you will see a combination of Claude’s and weber signs

Question 34

Strokes of the basal pons

Answer 34

Contralateral spastic paralysis with a babinski, neck and lower face

Question 35

Tegmentumm stroke

Answer 35

Ipsilateral sensory loss to the face and contralateral loss of fine touch etc of the body below the neck

Question 36

Locked in Syndrome

Answer 36

Involves the basillar artery. Patient appears to be in a coma but is not comatose

Question 37

Strokes of the upper PCA can result in what

Answer 37

Significant memory impairment

Question 38

Medulla strokes

Wallenberg syndrome
Also called lateral medullary syndrome or PICA syndrome

Answer 38

Contralateral: loss of pain and temperature in the body below the neck

Ipsilateral loss of pain a nd temp in the face, vertigo, nystagmus, nausea, and a horners syndrome with symptoms of the nucleus ambiguous

Question 39

Medulla strokes

Medial medulllary syndrome

Answer 39

Contralateral: loss of fine touch and spastic paralysis with a babinski below the neck and deviation to the side of the lesion